Behavioural Diversity Study in Bottlenose Dolphin (Tursiops truncatus) Groups and Its Implications for Welfare Assessments.

In the recent past, animal welfare studies have tried to determine the best animal welfare measures and indicators. Expression of behavioural diversity is considered a potential positive welfare indicator, and to the authors' knowledge, it has not been validated nor studied in cetaceans. For the first time, a behavioural diversity study on bottlenose dolphins (Tursiops truncatus) groups was conducted at six European facilities. The study was carried out by the animal care staff, biologists and veterinarians and included 54 dolphins housed in several group compositions at the different participating facilities. The goal of our study was to analyse behavioural diversity in bottlenose dolphins at the group level to investigate how particular factors might impact the diversity of behaviours within the group and to discuss its implications for dolphin welfare assessments. Eight factors (i.e., "observer location", "number of individuals", "age class", "sex", "social grouping", "presence/absence of leading male", "presence/absence of visitors" and "enrichment provision") impacted the behavioural diversity of the observed groups, while no significant impact of the factors "time of day" and "activity before/after observation" could be found. Our study showed the feasibility of this kind of approach for cetaceans under professional care and the relevance to considering this parameter in dolphin welfare studies, despite certain limitations that warrant further research.

Physiological Parameters Monitored on Bottlenose Dolphin Neonates (Tursiops truncatus, Montagu 1821) over the First 30 Days of Life.

Bottlenose dolphins (Tursiops truncatus) have been bred under human care for more than 60 years. Calves up to 30 days of life have presented the highest mortality rate, although comparable data for free-ranging neonates within this age group is not available. Husbandry measures to increase survivability have therefore been constantly improved. This work shows the results of a structured veterinary program that established the procedures to collect relevant physiological parameters on 13 calves during their first 30 days of life. Standardized observation protocols facilitated statistical analysis of the respiratory pattern, nursing, morphometric measurements and bloodwork. These allow early detection of health issues. Healthy neonates had longer apnea duration, despite the shape and size of the facility. The nursing pattern showed that successful calves started nursing 3 to 18 h postpartum. Although with different individual patterns, a steady increase in suckling time occurs during the first 24 h of life. The healthy neonates grew 0.428 ± 0.102 kg per day and the complete blood count profile, glucose, iron, blood urea nitrogen (BUN), total protein, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Gamma-glutamyl transferase (GGT), creatinine and electrolytes values considered normal for healthy calves are provided. Furthermore, cholesterol, triglycerides, α-amylase, lipase, magnesium and cortisol are reported for the first time for such young calves. A list of indications for prompt intervention is included.

The seal louse (Echinophthirius horridus) in the Dutch Wadden Sea: investigation of vector-borne pathogens.

BACKGROUND: Belonging to the anopluran family Echinophthiriidae, Echinophthirius horridus, the seal louse, has been reported to parasitise a broad range of representatives of phocid seals. So far, only a few studies have focused on the vector function of echinophthiriid lice, and knowledge about their role in pathogen transmission is still scarce. The current study aims to investigate the possible vector role of E. horridus parasitising seals in the Dutch Wadden Sea. METHODS: E. horridus seal lice were collected from 54 harbour seals (Phoca vitulina) and one grey seal (Halichoerus grypus) during their rehabilitation period at the Sealcentre Pieterburen, The Netherlands. DNA was extracted from pooled seal lice of individual seals for molecular detection of the seal heartworm Acanthocheilonema spirocauda, the rickettsial intracellular bacterium Anaplasma phagocytophilum, and the cell wall-less bacteria Mycoplasma spp. using PCR assays. RESULTS: Seal lice from 35% of the harbour seals (19/54) and from the grey seal proved positive for A. spirocauda. The seal heartworm was molecularly characterised and phylogenetically analysed (rDNA, cox1). A nested PCR was developed for the cox1 gene to detect A. spirocauda stages in seal lice. A. phagocytophilum and a Mycoplasma species previously identified from a patient with disseminated 'seal finger' mycoplasmosis were detected for the first time, to our knowledge, in seal lice. CONCLUSIONS: Our findings support the potential vector role of seal lice in the transmission of A. spirocauda and reveal new insights into the spectrum of pathogens occurring in seal lice. Studies on vector competence of E. horridus, especially for bacterial pathogens, are essentially needed in the future as these pathogens might have detrimental effects on the health of seal populations. Furthermore, studies on the vector role of different echinophthiriid species infecting a wide range of pinniped hosts should be conducted to extend the knowledge of vector-borne pathogens.

Lungworm seroprevalence in free-ranging harbour seals and molecular characterisation of marine mammal MSP.

Harbour seals (Phoca vitulina) are frequently infected with the lungworms Otostrongylus circumlitus and Parafilaroides gymnurus. The infection is often accompanied by secondary bacterial infections and can cause severe bronchopneumonia and even death in affected animals. Hitherto, the detection of lungworm infections was based on post mortem investigations from animals collected within stranding networks and a valid detection method for live free-ranging harbour seals was not available. Recently, an ELISA was developed for detecting lungworm antibodies in harbour seal serum, using major sperm protein (MSP) of the bovine lungworm, Dictyocaulus viviparus as recombinant diagnostic antigen. To determine lungworm seroprevalence in free-ranging harbour seals, serum was taken from four different seal age groups (n = 313) resulting in an overall prevalence of 17.9% (18.9% of males, 16.7% of females). 0.7% of harbour seals up to six weeks of age were seropositive, as were 89% of seals between six weeks and six months, 53.6% between six and 18 months and 24.2% of seals over 18 months of age. In the 18 months and over age group, seropositive animals showed statistically significant reductions in body weight (P = 0.003) and length (P < 0.001). Sera from lungworm infected harbour seals in rehabilitation (n = 6) revealed that duration of antibody persistence may be similar to that of lungworm infected cattle, but further studies are needed to confirm this. Phylogenetic analyses of MSP sequences of different marine and terrestrial mammal parasitic nematodes revealed that lungworm MSP of the genus Dictyocaulus (superfamily Trichostrongyloidea) is more closely related to metastrongylid marine mammal lungworms than to trichostrongylid nematodes of terrestrial hosts.

Structural characterisation of Toll-like receptor 1 (TLR1) and Toll-like receptor 6 (TLR6) in elephant and harbor seals.

Pinnipeds are a diverse clade of semi-aquatic mammals, which act as key indicators of ecosystem health. Their transition from land to marine environments provides a complex microbial milieu, making them vulnerable to both aquatic and terrestrial pathogens, thereby contributing to pinniped population decline. Indeed, viral pathogens such as influenza A virus and phocine distemper virus (PDV) have been identified as the cause of several of these mass mortality events. Furthermore, bacterial infection with mammalian Brucella sp. and methicillin-resistant Staphylococcus aureus strains have also been observed in marine mammals, posing further risk to both co-habiting endangered species and public health. During these disease outbreaks, mortality rates have varied amongst different pinniped species. Analyses of innate immune receptors at the host-pathogen interface have previously identified variants which may drive these species-specific responses. Through a combination of both sequence- and structure-based methods, this study characterises members of the Toll-like receptor (TLR) 1 superfamily from both harbour and elephant seals, identifying variations which will help us to understand these species-specific innate immune responses, potentially aiding the development of specific vaccine-adjuvants for these species.

SURGICAL TREATMENT OF OSTEOARTHRITIS IN HARBOR SEALS (PHOCA VITULINA).

In 2012, 543 harbor seals (Phoca vitulina) and 124 grey seals (Halichoerus grypus) were admitted to the Seal Rehabilitation and Research Centre in Pieterburen, The Netherlands. In 19 seals (3%), signs of infection in a hind flipper were observed. Initial treatment consisting of antibiotics and anti-inflammatory drugs resolved the symptoms in 15 animals. In four harbor seals, estimated to be 3 to 4 mo old, a necrotizing infection developed that resulted in osteoarthritis of the tarsus or tibiotarsal joint or both. Bacterial culture revealed the presence of polymicrobial infection in three of the four animals. Treatment consisted of amputation of the hind flipper under general anesthesia combined with tumescent anesthesia in the operation field. Amputations were done at the diaphysis of the tibia and fibula. After resecting these bones, the flipper was discarded, leaving a good muscle-skin cuff to cover the edges of the bones and close the skin without tension. The estimated blood loss varied between <50 to 150 ml. Healing was uneventful, and both antibiotics and analgesics were gradually reduced according to the individual response. The seals did not show any functional impairment 1 mo postoperatively. After release to the sea, scrutinous revision of all radiographs showed signs of osteomyelitis in at least one animal in the proximal part of the tibia, also present preoperatively. It is concluded that tumescent anesthesia in seals may reduce perioperative blood loss and that a lower leg amputation is a surgically easy and clean approach for the treatment of osteoarthritis of the hind flipper of seals, giving good functional results (diving, catching fish, exiting a pool, and moving on land).

Vertebral column deformities in white-beaked dolphins from the eastern North Atlantic.

Five white-beaked dolphins Lagenorhynchus albirostris with outwardly vertebral kyphosis, kyphoscoliosis or lordosis were identified during a photo-identification survey of over 400 individuals (2002-2013) in Faxaflói and Skjálfandi Bays, Iceland. In addition, 3 stranding reports from Denmark, The Netherlands and the UK were analysed, providing both external observation and post mortem details of axial deviations of the vertebral column in this species. Two of the free-ranging cases and 2 of the stranded specimens appeared to have an acquired disease, either as a direct result of trauma, or indirectly from trauma/wound and subsequent infection and bony proliferation, although we were unable to specifically identify the causes. Our data represent a starting point to understand vertebral column deformations and their implications in white-beaked dolphins from the eastern North Atlantic. We recommend for future necropsy cases to conduct macro- and microscopic evaluation of muscle from both sides of the deformed region, in order to assess chronic or acute conditions related to the vertebral deformations and cause of death.

Harbour seal (Phoca vitulina) PMN and monocytes release extracellular traps to capture the apicomplexan parasite Toxoplasma gondii.

Extracellular traps (ETs) are composed of nuclear DNA as backbone adorned with histones, cytoplasmic antimicrobial peptides/proteins which are released from a range of vertebrate and invertebrate host immune cells in response to several invading pathogens. Until now this ancient novel innate defence mechanism has not been demonstrated in any marine mammal. Interactions of harbour seal (Phoca vitulina)-PMN and -monocytes with viable tachyzoites of Toxoplasma gondii were investigated in this respect in vitro. For the demonstration and quantification of harbour seal PMN- and monocyte-derived ETs, extracellular DNA was stained with Sytox Orange. Fluorescence assays as well as scanning electron microscopy (SEM) analyses demonstrated PMN- and monocyte-promoted ET formation rapidly being induced upon contact with T. gondii-tachyzoites. The co-localisation of extracellular DNA decorated with histones (H3), neutrophil elastase (NE) and myeloperoxidase (MPO) in parasite entrapping structures confirmed the classical characteristics of PMN- and monocyte-promoted ETs. Exposure of harbour seal PMN and monocytes to viable tachyzoites resulted in a significant induction of ETs when compared to negative controls. Harbour seal-ETs were efficiently abolished by DNase I treatment and were reduced after PMN and monocytes pre-incubation with the NADPH oxidase inhibitor diphenilane iodondium. Tachyzoites of T. gondii were firmly entrapped and immobilised within harbour seal-ET structures. To our best knowledge, we here report for the first time on T. gondii-induced ET formation in harbour seal-PMN and -monocytes. Our results strongly indicate that PMN- and monocyte-triggered ETs represent a relevant and ancient conserved effector mechanism of the pinniped innate immune system as reaction against the pathogenic protozoon T. gondii and probably against other foreign pathogens occurring in the ocean environment.

Identification of DNA sequences that imply a novel gammaherpesvirus in seals.

Various herpesviruses have been discovered in marine mammals and are associated with a wide spectrum of disease. In the present study we describe the detection and phylogenetic analysis of a novel gammaherpesvirus, tentatively called phocine herpesvirus 7 (PhHV-7), which was detected in samples collected during an outbreak of ulcerative gingivitis and glossitis from juvenile harbour seals (Phoca vitulina) at the Seal Rehabilitation and Research Centre, the Netherlands. The presence of this novel gammaherpesvirus was confirmed by viral metagenomics, while no other viruses other than four novel anelloviruses were detected. However, PhHV-7 DNA was also detected in harbour and grey seals (Halichoerus grypus) without gingivitis or glossitis. Genetic analysis of the partial polymerase gene of PhHV-7 detected in both species revealed limited sequence variation. Additional studies are needed to elucidate whether the viruses discovered played a role in the disease observed.

Molecular epidemiology of seal parvovirus, 1988-2014.

A novel parvovirus was discovered recently in the brain of a harbor seal (Phoca vitulina) with chronic meningo-encephalitis. Phylogenetic analysis of this virus indicated that it belongs to the genus Erythroparvovirus, to which also human parvovirus B19 belongs. In the present study, the prevalence, genetic diversity and clinical relevance of seal parvovirus (SePV) infections was evaluated in both harbor and grey seals (Halichoerus grypus) that lived in Northwestern European coastal waters from 1988 to 2014. To this end, serum and tissue samples collected from seals were tested for the presence of seal parvovirus DNA by real-time PCR and the sequences of the partial NS gene and the complete VP2 gene of positive samples were determined. Seal parvovirus DNA was detected in nine (8%) of the spleen tissues tested and in one (0.5%) of the serum samples tested, including samples collected from seals that died in 1988. Sequence analysis of the partial NS and complete VP2 genes of nine SePV revealed multiple sites with nucleotide substitutions but only one amino acid change in the VP2 gene. Estimated nucleotide substitution rates per year were 2.00 × 10(-4) for the partial NS gene and 1.15 × 10(-4) for the complete VP2 gene. Most samples containing SePV DNA were co-infected with phocine herpesvirus 1 or PDV, so no conclusions could be drawn about the clinical impact of SePV infection alone. The present study is one of the few in which the mutation rates of parvoviruses were evaluated over a period of more than 20 years, especially in a wildlife population, providing additional insights into the genetic diversity of parvoviruses.

Novel B19-like parvovirus in the brain of a harbor seal.

Using random PCR in combination with next-generation sequencing, a novel parvovirus was detected in the brain of a young harbor seal (Phoca vitulina) with chronic non-suppurative meningo-encephalitis that was rehabilitated at the Seal Rehabilitation and Research Centre (SRRC) in the Netherlands. In addition, two novel viruses belonging to the family Anelloviridae were detected in the lungs of this animal. Phylogenetic analysis of the coding sequence of the novel parvovirus, tentatively called Seal parvovirus, indicated that this virus belonged to the genus Erythrovirus, to which human parvovirus B19 also belongs. Although no other seals with similar signs were rehabilitated in SRRC in recent years, a prevalence study of tissues of seals from the same area collected in the period 2008-2012 indicated that the Seal parvovirus has circulated in the harbor seal population at least since 2008. The presence of the Seal parvovirus in the brain was confirmed by real-time PCR and in vitro replication. Using in situ hybridization, we showed for the first time that a parvovirus of the genus Erythrovirus was present in the Virchow-Robin space and in cerebral parenchyma adjacent to the meninges. These findings showed that a parvovirus of the genus Erythrovirus can be involved in central nervous system infection and inflammation, as has also been suspected but not proven for human parvovirus B19 infection.

Adherencia al tratamiento farmacológico en pacientes hipertensos del Hospital Comunitario de Yungay, 2012 / Adherence to pharmacotherapy of hypertensive patients of Yungay’s Communitarian Hospital, 2012

INTRODUCCIÓN: Las enfermedades cardiovasculares siguen siendo la principal causa de muerte en Chile. Entre ellas, la hipertensión arterial afecta a aproximadamente un tercio del país, pero solo un 45,9 por ciento de la población en tratamiento alcanza niveles normales de presión arterial. OBJETIVO: Determinar la adherencia al tratamiento farmacológico de un grupo de pacientes hipertensos en control en el consultorio del Hospital Comunitario de Yungay, mediante la aplicación del Test de Morisky-Green y analizar factores que podrían estar relacionados con el nivel de adherencia. MATERIALES Y MÉTODO: Estudio descriptivo prospectivo observacional en el que se entrevistó a pacientes atendidos en el consultorio del Hospital Comunitario de Yungay durante Agosto y Septiembre del 2012, utilizando el Test de Morisky Green y agregando otras preguntas en relación a género, edad, escolaridad, red de apoyo y número de medicamentos. Además, en todos los casos se midieron los niveles de presión arterial. RESULTADOS: Se incluyeron 74 pacientes. El 70,3 por ciento eran mujeres. El promedio de edad fue de 65,3 años. Solo un 45,9 por ciento presentó adherencia a tratamiento y un 47,9 por ciento obtuvo presión arterial bajo control. Entre los factores estudiados, el 51 por ciento tenía educación básica incompleta y el promedio de antihipertensivos fue de 1,75. DISCUSIÓN: La falta de adherencia a tratamiento tiene relación directa con el mal control de presión arterial, por lo que incrementar su investigación y educación en el seguimiento de los pacientes hipertensos debería ser uno de los principales objetivos de los programas cardiovasculares.

Introduction: Cardiovascular diseases are the main cause of death in Chile. Among them, High Blood Pressure or Hypertension or Arterial Hypertension affects about 1/3 of the country, but only 45.9 percent of the population under treatment reaches normal levels of blood pressure. Objective: determinate the adherence to treatment in a group of hypertensive patients from the Health Center of Yungay’s Communitarian Hospital, by using Morisky-Green Test, and analyze the factors that could be related to the level of adherence. Materials and methods: descriptive, observational and prospective study, perfomed by an interview of hypertensive patients from the Health Center of Yungay’s Communitarian Hospital between August and September 2012, using Morisky-Green Test and adding other questions related to gender, age, school level, support network and number of medications. Besides, blood pressure was taken to all patients. Results: 74 patients were included. 74 percent were women. The age average was 65.3 years. Only 45.9 percent had adherence to treatment and 47.9 percent had blood pressure under control. Within the studied factors, 51 percent of patients had primary educational level incomplete and the average of antihypertensive medications was 1.75. Conclusions and Discussion: The lack of adherence to treatment is directly related to a bad blood pressure control. An increment in investigation and education of the monitoring of hypertensive patients, should be one of the main goals of the cardiovascular programs.

Entrega de información y voluntariedad en el consentimiento presunto de la ley de donación de órganos en Chile / Information delivery and voluntariness in presumed consent in the Chilean organ donation law

A principios del año 2010 se reformó en Chile la antigua ley de donación y trasplante de órganos de 1996, instaurando una nueva forma de hacer donantes a los ciudadanos a través del llamado consentimiento presunto. A partir de lo anterior se analiza este concepto en relación a los pilares fundamentales del consentimiento informado; información, voluntariedad y capacidad, enfocado principalmente en los dos primeros. Respecto al principio de voluntariedad es claramente violado ya que actualmente no es necesario que la persona se manifieste para ser donante, sino que es posicionada automáticamente como tal a no ser que escoja lo contrario. Continuando con el análisis, se puede ver como la autoridad ha dejado de lado el principio de información, no poniendo énfasis en éste, a pesar de que la evidencia indica que es una forma efectiva de convencer a pacientes no donantes. La promulgación de la ley debe ser complementada con entrega de información y educación a los distintos sectores cívicos.

In early 2010, in Chile, the law of organ donation and transplantation from 1996 was amend ended, establishing a new form of organ donation to citizens through the presumed consent. From the above, this concept is analyzed according to the fundamental pillars of informed consent; information, voluntariness and capacity, mainly focused on the first two. Regarding the principle of voluntary it is clearly violated, as it is no longer necessary that the person chooses to be a donor if one does not manifest their willingness to not be one. Continuing with the analysis, it can be seen how the authority has neglected the principle of information, not emphasizing it, even though the evidence indicates that it is an effective way to convert non-donors. The enactment of the law must be supplemented by providing information and education to civic sectors.(AU)om the above, this concept is analyzed according to the fundamental pillars of informed consent; information, voluntariness and capacity, mainly focused on the first two. Regarding the principle of voluntary it is clearly violated, as it is no longer necessary that the person chooses to be a donor if one does not manifest their willingness to not be one. Continuing with the analysis, it can be seen how the authority has neglected the principle of information, not emphasizing it, even though the evidence indicates that it is an effective way to convert non-donors. The enactment of the law must be supplemented by providing information and education to civic sectors.

Prevalence of phocine distemper virus specific antibodies: bracing for the next seal epizootic in north-western Europe.

In 1988 and 2002, two major phocine distemper virus (PDV) outbreaks occurred in harbour seals (Phoca vitulina) in north-western European coastal waters, causing the death of tens of thousands seals. Here we investigated whether PDV is still circulating among seals of the Dutch coastal waters and whether seals have protective serum-antibodies against PDV. Therefore seal serum samples, collected from 2002 to 2012, were tested for the presence of PDV-neutralizing antibodies. Antibodies were detected in most seals in 2002 and 2003 while after 2003 antibodies were detected only in seals less than two month-old and adult seals that probably had survived the 2002 PDV-epizootic. We estimated the current proportion of seals with antibodies against PDV at 11%. These findings suggest that at present the vast majority of seals are not immune to PDV infection. PDV re-introduction in this area may cause a major epizootic with infection of >80% and mass-mortality of >50% of the population.

Aspectos epidemiológicos y percepciones del acné vulgar en escolares de secundaria del Cono Sur de Lima-Perú / Epidemiologic aspects and perceptions of acne vulgaris in secondary scholar pupils from South Lima-Peru

Objetivo: Determinar la prevalencia, las características epidemiológicas y las percepciones sobre la causa de acné vulgar. Material y métodos: Estudio descriptivo transversal en escolares de secundaria de Colegios Nacionales del distrito de San Juan de Miraflores, Cono Sur de Lima. Se aplicó una encuesta y un examen físico especializado. La severidad del acné se valoró aplicando la graduación global de acné de la FDA. Resultados: Se estudiaron 548 sujetos con edad promedio de 14.29 más menos 1.67, 54.6 por ciento de sexo femenino. El 48.7 por ciento reconoció alguna causa de acné, las más importantes "comer grasa" (26.6 por ciento) y "desarrollo" (10.8 por ciento). El 37 por ciento tenía antecedentes familiares de acné. La apreciación subjetiva de padecer acné fue del 37 por ciento. Consideraron factores agravantes de acné a alimentos como las frituras (49.5 por ciento), estrés (11.7 por ciento), menstruación (3 por ciento) y sudor (0.5 por ciento). Se halló una frecuencia de acné de 46.6 por ciento. El sexo masculino (48.6 por ciento) se afectó más que el sexo femenino (44.8 por ciento), concentrándose los casos leves en el sexo femenino. La frecuencia de acné fue creciente a más edad. Los factores asociados a acné fueron apreciación subjetiva de padecer acné (p menor 0.001), tabaquismo (p igual 0.036) y antecedentes familiares (p igual 0.042). Conclusiones: La prevalencia de acné en escolares es de 46.6 por ciento. Una gran proporción de los pacientes afectados no perciben tener acné, desestimando su importancia. El tabaco y los antecedentes familiares son factores importantes asociados al acné.

Síndrome pulmonar por hantavirus en población infantil en Chile: Regiones IX y X, 1998-2000 / Hantavirus pulmonary syndrome in children from Chile: IX and X regions, 1998-2000

El síndrome pulmonar por hantavirus (SPH) ha estado presente en Chile desde 1993 y ha sido detectado desde 1997 en la IX región. Es una grave zoonosis con alta mortalidad, que afecta a gente joven incluyendo niños. Se ha estimado oportuno dar a conocer nuestra experiencia en la atención de 6 pacientes pediátricos, atendidos en las unidades de cuidados intensivos y aislamiento en el Hospital Regional de Temuco, entre enero de 1998 y enero de 2000 mediante un estudio descriptivo de la experiencia del equipo de salud en la atención de estos pacientes. La información clínico-epidemiológica se extrajo de las fichas clínicas y visitas a terreno. Se efectuó la confirmación etiológica por detección de anticuerpos específicos -IgM e IgG- mediante tests de ELISA y la pesquisa de genoma viral por reacción de polimerasa en cadena (TR RPC). Edad promedio 6 años 5 meses (rango: 2-10 años), relación varón/mujer: 4/2. Procedencia: de área rural cordillerana (n:4), costera (n:2). Todos tuvieron fiebre elevada, dolor abdominal intenso, vómitos, mialgias, compromiso respiratorio clínico y radiológico. Hallazgos hematológicos constantes: trombocitopenia, leucocitosis, inmunoblastos o linfocitosis con formas atípicas. La confirmación etiológica (IgM e IgG positivas) se alcanzó en todos. En dos pacientes se detectó en sangre la secuencia genética viral de hantavirus cepa Andes. Dos pacientes en los cuales se requirió ventilación mecánica y manejo del shock, finalmente fallecieron; los otros enfermos tuvieron una recuperación rápida. No existe una terapia específica conocida para el SPH, la prevención, una sospecha y diagnóstico oportunos y el tratamiento agresivo son las estrategias actuales para luchar contra esta enfermedad

Tuberculosis infantil: experiencia regional en la Araucanía en veinte años / Pediatric tuberculosis: experience at the Araucania region during 20 years

Entre 1979 y 1998 se trataron con diagnóstico de tuberculosis (TBC), 120 pacientes menores de 15 años en el Servicio de Pediatría del Hospital Regional de Temuco. Todos recibieron isoniacida + rifampicina + pirazinamida diariamente por 1 a 2 meses. En TBC meníngea o grave se adicionó estreptomicina como cuarto fármaco antituberculoso. En fase intermitente, generalmente ambulatoria, se empleó isoniacida + rifampicina bimensual por 5 a 7 meses. El diagnóstico de tuberculosis fue bacteriológica en 65 pacientes (54 POR CIENTO), en el resto tuvo fundamentación clínica-epidemiológica. La enfermedad predominó en escolares de origen rural y ascendencia mapuche. En 48 por ciento se obtuvo el antecedente de TBC familiar. En 50 por ciento no se encontró cicatriz BCG. En 70 por ciento hubo compromiso pulmonar exclusivo, en 20 por ciento extrapulmonar solamente y en 10 por ciento asociación. El compromiso del SNC y aparato osteoarticular siguieron en frecuencia al pulmón. Fallecieron 5 pacientes (letalidad 4,1 por ciento). Hubo elevación transitoria de transaminasas en 4,1 por ciento. Se observó recidiva en un paciente. La vacunación BCG, el adecuado manejo de la TBC del adulto y control de los contactos son estrategias fundamentales en la reducción y eliminación de la TBC infantil en Chile.